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Оказание высококачественной комплексной помощи в области склероза в Германии: проблемы и региональные модели.

Множественная склерозовая (МС) помощь в Германии вступила в стадию, когда терапевтический прогресс все больше сдерживается возможностями родовспоможения. Более ранняя диагностика, более широкий доступ к высокоэффективным методам лечения заболеваний (ДМТ) и более совершенные стратегии мониторинга расширили возможности для достижения благоприятных долгосрочных результатов. В то же время эти достижения усилили потребность в специализированных экспертных знаниях, инфильтрации и инфраструктуре мониторинга, оперативном доступе к изображениям, структурированных процедурах обеспечения безопасности и м

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… However, DMT non-treatment should not be equated with undertreatment, as treatment status may reflect disease course, age, comorbidity, contraindications, treatment preferences, or the absence of an indication for DMT, particularly in progressive disease. …

Obesity and Cancer: A Current Overview of Epidemiology, Pathogenesis, Outcomes, and Management.

BackgroundObesity or excess body fat is a major global health challenge that has not only been associated with diabetes mellitus and cardiovascular disease but is also a major risk factor for the development of and mortality related to a subgroup of cancer. This review focuses on epidemiology, the relationship between obesity and the risk associated with the development and recurrence of cancer and the management of obesity.MethodsA literature search using PubMed and Google Scholar was performed and the keywords 'obesity' and cancer' were used. The search was limited to research papers publish

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… 0.50–1.24) Ovarian cancer | 4 | 1.03 (0.75–1.41) | 4 | 1.06 (0.82–1.37) The inferior outcomes in obese patients noted in certain cancers could be due to several factors, such as an underlying metabolic syndrome, hormonal factors related to some endocrine-dependent cancers, low physical activity, and undertreatment …

Polypharmacy and medication use in patients with chronic kidney disease with and without kidney replacement therapy compared to matched controls.

BackgroundThis study aims to examine polypharmacy (PP) prevalence in patients with chronic kidney disease (CKD) Stage G4/G5 and patients with kidney replacement therapy (KRT) compared with matched controls from the general population. Furthermore, we examine risk factors for PP and describe the most commonly dispensed medications.MethodsDutch health claims data were used to identify three patient groups: CKD Stage G4/G5, dialysis and kidney transplant patients. Each patient was matched to two controls based on age, sex and socio-economic status (SES) score. We differentiated between 'all medic

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… Undertreatment has been repeatedly associated with unfavourable outcomes in dialysis patients [ 49 ]. …

A Practical Approach to Managing Patients With Myasthenia Gravis-Opinions and a Review of the Literature.

When the diagnosis of myasthenia gravis (MG) has been secured, the aim of management should be prompt symptom control and the induction of remission or minimal manifestations. Symptom control, with acetylcholinesterase inhibitors such as pyridostigmine, is commonly employed. This may be sufficient in mild disease. There is no single universally accepted treatment regimen. Corticosteroids are the mainstay of immunosuppressive treatment in patients with more than mild MG to induce remission. Immunosuppressive therapies, such as azathioprine are prescribed in addition to but sometimes instead of

Cancer in Pregnancy: Therapeutic Decisions at the Intersection of Two Lives.

Background: Cancer during pregnancy is a rare but increasingly encountered condition due to delayed childbearing and improved survival of women with cancer. The coexistence of malignancy and pregnancy poses complex diagnostic and therapeutic challenges, requiring careful balance between maternal prognosis and fetal safety. Objective: This review aims to summarize current evidence on the diagnosis and multidisciplinary management of cancer during pregnancy, focusing on the safe use of oncologic therapies, obstetric decision-making, and maternal and fetal outcomes. Methods: A narrative review wa

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… However, most current recommendations are extrapolated from non-pregnant populations, limiting therapeutic precision and potentially resulting in both maternal undertreatment and unnecessary fetal exposure. …

Fracture Risk of Long Bone Metastases: A Review of Current and New Decision-Making Tools for Prophylactic Surgery.

Long bone pathological fractures very much reflect bone metastases morbidity in many types of cancer. Bearing in mind that they not only compromise patient function but also survival, identifying impending fractures before the actual event is one of the main concerns for tumor boards. Indeed, timely prophylactic surgery has been demonstrated to increase patient quality of life as well as survival. However, early surgery for long bone metastases remains controversial as the current fracture risk assessment tools lack accuracy. This review first focuses on the gold standard Mirels rating system.

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… Limitations of the Mirels Scoring System However, Mirels scores of 7 or 8/12 are related to 4% and 15% fracture risks, respectively, which can lead to undertreatment, although the false-positive rate increases (from 6% for a Mirels score = 8/12, up to 22% for a Mirels score = 7/12). …

Association of response endpoints with survival outcomes in multiple myeloma.

Since the introduction of the proteasome inhibitor bortezomib and the immunomodulatory drugs (IMiDs) thalidomide and lenalidomide, more patients with multiple myeloma are achieving deep, durable responses and disease control, and are living longer. These improvements have afforded more robust analyses of the relationship between response and survival. Generally, these studies have demonstrated that improvements in the quality of response across all stages of treatment are associated with better disease control and longer survival. Thus, achievement of maximal response should be strongly consid

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… Undertreatment could result in failure to achieve a potential cure in standard-risk patients or rapid loss of disease control in high-risk patients. …

A scoping review of the literature on the application and usefulness of the Problem Management Plus (PM+) intervention around the world.

BackgroundGiven the high rates of common mental disorders and limited resources, task-shifting psychosocial interventions are needed to provide adequate care. One such intervention developed by the World Health Organization is Problem Management Plus (PM+).AimsThis review maps the evidence regarding the extent of application and usefulness of the PM+ intervention, i.e. adaptability, feasibility, effectiveness and scalability, since it was introduced in 2016.MethodWe conducted a scoping review of seven literature databases and grey literature from January 2015 to February 2024, to identify peer

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… Undertreatment of people with major depressive disorder in 21 countries . Br J Psychiatry 2017 ; 210 ( 2 ): 119 –24. 27908899 10.1192/bjp.bp.116.188078 PMC5288082 90 Too EK , Abubakar A , Nasambu C , Koot HM , Cuijpers P , Newton CR , et al. …

Cardiometabolic Comorbidities in Cancer Survivors: JACC: CardioOncology State-of-the-Art Review.

There are nearly 17 million cancer survivors in the United States, including those who are currently receiving cancer therapy with curative intent and expected to be long-term survivors, as well as those with chronic cancers such as metastatic disease or chronic lymphocytic leukemia, who will receive cancer therapy for many years. Current clinical practice guidelines focus on lifestyle interventions, such as exercise and healthy eating habits, but generally do not address management strategies for clinicians or strategies to increase adherence to medications. We discuss 3 cardiometabolic comor

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… Status of dyslipidemia management and statin undertreatment in Korean cancer survivors: a Korean National Health and Nutrition Examination Survey study. Eur J Prev Cardiol. 2021;28(8):864–872. doi: 10.1177/2047487320905722. 83. Armenian S.H., Xu L., Ky B., et al. …

Abscopal Effect in Radiation Therapy: The Immune Mechanisms and Clinical Advances.

The abscopal effect is a systemic antitumor response to localized radiotherapy (RT) that has emerged as a central focus in the era of immunotherapy. Clinical evidence demonstrates that local RT can induce regression of distant, nonirradiated metastases, including cases of complete remission. However, the effect remains unpredictable, with marked variation in clinical outcomes ranging from complete regression to paradoxical progression. The mechanistic basis for this heterogeneity and optimal strategies to enhance abscopal effects remain incompletely understood. This review synthesizes current

Clinical decision support in hematological malignancies using a case-grounded AI agent.

Multidisciplinary tumor boards integrate longitudinal treatment histories, molecular profiling and rapidly evolving evidence to guide decisions in hematological malignancies, yet access to this level of subspecialty deliberation is increasingly uneven. Here we develop HemaGuide, a locally deployable, modular large language model agent that converts unstructured clinical documents into structured case representations, autonomously routes cases to specialized decision modes ('guideline', 'advanced' and 'molecular') and grounds recommendations in disease-specific guideline flowcharts and a clinic

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… reporting duration (seconds), prompt tokens, completion tokens and total tokens per case, Supplementary Table 11 Classification of all discordant cases across the benchmark, silent trial and external validation cohorts by entity and primary discordance reason (alternative regimen selection, overtreatment, undertreatment …

Exploring Cost-Effectiveness of the Comprehensive Geriatric Assessment in Geriatric Oncology: A Narrative Review.

The Comprehensive Geriatric Assessment (CGA) and the corresponding geriatric interventions are beneficial for community-dwelling older persons in terms of reduced mortality, disability, institutionalisation and healthcare utilisation. However, the value of CGA in the management of older cancer patients both in terms of clinical outcomes and in cost-effectiveness remains to be fully established, and CGA is still far from being routinely implemented in geriatric oncology. This narrative review aims to analyse the available evidence on the cost-effectiveness of CGA adopted in geriatric oncology,

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… i) improves clinical outcomes by helping select the most appropriate therapy [ 27 ], (ii) promotes the inclusion of patient preferences in the decision-making process [ 28 , 29 , 30 ], (iii) improves communication between oncologists and patients [ 28 , 29 , 30 ], (iv) reduces the risk of over- and undertreatment …

Current Management and the New Paradigm for ALK+ NSCLC After CROWN.

The 7-year update of the phase 3 CROWN study is the most impressive milestone in anaplastic lymphoma kinase (ALK)+ non-small-cell lung cancer (NSCLC) since the discovery of the oncogene 20 years ago and inaugurates an entire new paradigm. The progression-free survival (PFS) plateau at a high level > 50%, with an estimated very low annual progression rate < 2% after the third year, suggests that lorlatinib can inactivate the disease in most patients. The complete abrogation of on-target resistance abolishes ALK tyrosine kinase inhibitor (TKI) sequencing and will seriously impact future drug dev

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… First, it reduced exposure to subsequent ALK TKI post-crizotinib by approximately 1/3 (54% in ALEX and 58% in ALESIA banning crossover, vs. 83% in J-ALEX and 82% in ALTA-1L permitting crossover), which corresponds to an artificial undertreatment of the control arm by today’s standards, as 2G TKI are …

Oncolytic virus therapy in the elderly: immune frailty, challenges, and perspectives.

With global aging accelerating, cancer incidence among older adults is rapidly increasing. Individuals aged ≥65 years now represent 64% of new cancer cases and 71.3% of cancer-related deaths worldwide. This population exhibits a distinct immune imbalance-driven by tumor-induced immunosuppression, immunosenescence, and inflammaging-which contributes to poor tolerance of standard therapies and suboptimal outcomes with PD-1/PD-L1 inhibitors. As an emerging immunotherapeutic strategy, oncolytic viruses (OVs) selectively infect tumor cells, induce immunogenic cell death (ICD), and activate the cGAS

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… EGALICAN-2 study in France: patients aged ≥70 accounted for only 17.7% of early-phase clinical trials | Systematic underrepresentation of older adults results in limited data on immunotoxicity and efficacy | Extrapolation from younger cohorts may lead to overtreatment, undertreatment, or insufficient …

Cancer in the Oldest-Old Population in the MENA Region: Epidemiology and Temporal Trends Based on GBD 2021.

IntroductionCancer among the oldest-old (aged ≥85) is an escalating public health concern, particularly in the Middle East and North Africa (MENA), where demographic aging is advancing rapidly.MethodsWe analyzed cancer incidence and mortality trends among the oldest-old in MENA from 1990 to 2021 using Global Burden of Disease (GBD) 2021 data, and compared these trends to global patterns.ResultsCancer incidence and mortality among the oldest-old in MENA increased substantially, surpassing global trends. Between 1990 and 2021, incidence rose by 54.2% in MENA vs 25.3% globally, while mortality in

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… complicate cancer diagnosis, treatment decisions, and outcomes, underscoring the need for tailored geriatric and public health strategies to address their specific vulnerabilities. 10 - 12 , 16 , 17 Older adults are also underrepresented in clinical trials and often receive either overtreatment or undertreatment …

Pharmacological Treatments and Therapeutic Drug Monitoring in Patients with Chronic Pain.

Pain is an unpleasant sensory and emotional experience that affects every aspect of a patient's life and which may be treated through different pharmacological and non-pharmacological approaches. Analgesics are the drugs most commonly used to treat pain, and in specific situations, the use of opioids may be considered with caution. These drugs, in fact, do not always induce optimal analgesia in patients, and several problems are associated with their use. The purpose of this narrative review is to describe the pharmacological approaches currently used for the management of chronic pain. We rev

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… Several responsible factors have been identified for therapeutic failure, including the ineffectiveness of pain measurement tools in daily practice, the difficulty of evaluating undertreatment, and the lack of strategies to reduce pain [ 181 ]. …

Structure and function of therapeutic antibodies approved by the US FDA in 2023.

In calendar year 2023, the United States Food and Drug Administration (US FDA) approved a total of 55 new molecular entities, of which 12 were in the class of therapeutic antibodies. Besides antibody protein drugs, the US FDA also approved another five non-antibody protein drugs, making the broader class of protein drugs about 31% of the total approved drugs. Among the 12 therapeutic antibodies approved by the US FDA, 8 were relatively standard IgG formats, 3 were bivalent, bispecific antibodies and 1 was a trivalent, bispecific antibody. In 2023, no new antibody-drug conjugates, immunocytokin

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… FDA-approved anti-IL-17A antibodies such as secukinumab (Cosentyx®) and ixekizumab (Taltz®), both of which are approved for treatment of PsO, block only IL-17A homodimer, and they would also be expected to block the IL-17AF heterodimer, but neither would block the IL-17F homodimer, which may lead to undertreatment …

Secondary antibody deficiencies: what's around the corner?

Secondary antibody deficiencies (SADs) are characterized by impaired humoral immunity, which can cause recurrent and severe infections. Several factors may contribute to SAD development, making it difficult to establish a clear etiological classification. This heterogeneity also leads to clinical variability, further complicating patient management and treatment strategies. Various diagnostic and therapeutic algorithms are often adapted from those used in primary antibody deficiencies, potentially resulting in under- or over-treatment. Key points include the decision to initiate Immunoglobulin

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… This approach is suitable for most of the SAD patients but may lead to an undertreatment of antibody deficiencies due to plasma cells depletion. …

The Continuum of Thyroid Disorders Related to Immune Checkpoint Inhibitors: Still Many Pending Queries.

BackgroundUntil more data are available to shed light on the thyroid disorders related to immune checkpoint inhibitors (ICPi) implemented for the treatment of hematological malignancies, the decision-making is guided by pertinent data derived mostly from solid tumors.MethodsThe present review provides a comprehensive and updated overview of the thyroid disorders related to ICPi, namely to inhibitors of cytotoxic T-lymphocyte antigen 4 (CTLA-4), programmed cell death (PD) 1 (PD-1), and the ligand of the latter (PD-L1).ResultsWith the increasing recognition of ir thyroid disorders, many outstand

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… The aim is to correct any clinically significant impairment of thyroid function, but clinicians need to rely on their clinical judgement to avoid either undertreatment or overtreatment. 9. …

Endothelial dysfunction in congenital adrenal hyperplasia due to 21-hydroxylase deficiency: current knowledge and novel biomarkers.

Congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency (21OHD) is a complex endocrine disorder characterized by impaired cortisol synthesis and androgen excess. Beyond its hormonal and metabolic implications, CAH has been increasingly associated with an elevated risk of cardiovascular complications, including endothelial dysfunction, a critical precursor to atherosclerosis and a risk factor for cardiovascular and metabolic diseases. This review explores the current knowledge on endothelial function in patients with CAH, focusing on the interplay between chronic hormonal imbalanc

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… Therefore, preventing long-term metabolic and cardiovascular complications depends on maintaining an optimal balance between overtreatment and undertreatment, however, it remains a significant challenge in both CCAH and NCCAH ( 67 ). …